How to Support Someone With an Eating Disorder
[Listen to an audio version of this blog HERE.]
The other day, a friend told me I'm an eating disorder "subject matter expert" and I laughed. Anecdotally, I have experience living with an eating disorder and going through treatment. I've talked to lots of doctors and psychologists and dietitians. I've talked with lots of other men and women who have suffered. I've researched eating disorders extensively in an attempt to figure out my own brain.
One of the most common questions I receive through this blog is how to help someone who might be suffering. People want to know how they can help, or if it's even possible to support someone who struggles with any form of disordered eating. Food is incredibly personal, and it can be tricky to talk about food or eating without triggering negative emotions in anyone, much less someone with an eating disorder. It's also not possible to help someone who doesn't want to be helped. Numerous friends and teammates came to me to see if I was okay prior to me actively seeking treatment. None of their outreach spurred me to seek help though. Keep in mind that people are inherently unchangeable.
First, I need to say that eating disorders look different on everyone and they aren't always visible. Some people look emaciated, some may appear to be overweight, and some may appear to be physically very health. Eating disorders are mental disorders with physical side effects. Eating disorders (or disordered eating) are a cluster of mental health conditions that revolve around unhealthy eating habits and patterns. Although the most commonly referenced eating disorders are Bulimia Nervosa, Anorexia Nervosa, and Binge Eating Disorder there are other forms of eating disorders, typically grouped under the single umbrella of Eating Disorder-Not Specified. This diagnosis is usually given to individuals who do not exhibit the specific symptoms of Anorexia Nervosa (withholding food from oneself), Bulimia Nervosa (purging after eating), or Binge Eating Disorder (BED) but still exhibit symptoms of disordered eating, such as:
1. Dressing in layers.
Attempting to hide weight (either excess weight or inadequate weight) can demonstrate a decline in mental health. People with eating disorders will often go to great measures to change their bodies. They might feel uncomfortable or unsafe in their bodies and dressing in layers may help mitigate these fears.
2. A fixation on weight or eating. Although focusing on improving one’s health is not inherently bad, individuals with eating disorders will fixate on eating habits, exercise regimens, and weight. They may obsessively research nutrition, workout incessantly, or show other signs of compulsive weight-controlling behaviors.
3. Difficulty eating with others. This is one of the most obvious signs that something is wrong. Individuals with eating disorders might feel shame or embarrassment when eating and may therefore try to avoid eating in the presence of others.
4. Developing food-based rituals and routines. Some people with eating disorders create rituals and routines around food as a way to exert some degree of control over their bodies. Common rituals include: cutting out entire food groups, eating within specific time frames, not allowing food to touch, or performing certain rituals around food, such as only eating while watching TV.
5. Withdrawal from friends and loved ones. Individuals with eating disorders might also demonstrate declining mental health by pulling away from family and friends, increasing secretive behavior, and seeming uninterested in activities that were previously loved.
6. Sleep disturbances. People with eating disorders may either sleep less or more than is normal. When I was sick, I often couldn't sleep due to hunger, while some people might sleep more than normal due to decreased energy stores.
7. Weight fluctuations. Although weight loss is certainly a symptom of eating disorders, weight gain (or the appearance of weight gain) can also be a symptom. Not getting enough nutrients can cause the body to initiate an inflammatory response, which can cause bloating and swelling, particularly in the face and extremities.
8. Unhealthy skin. Skin can show a lot about a person’s health—including mental health—and people with eating disorders might present with skin that is waxy, pale, or dull in appearance.
This is not an exhaustive list, but these are some common symptoms. If you notice a loved one presenting one or more of these symptoms, you may have cause for concern.
If you think someone you love is struggling with an eating disorder or disordered eating, there are some things you can do to help:
1. Encouraging them to seek help. Family members are not qualified to provide the same aid as mental health professionals, but they can be instrumental in helping people with eating disorders seek help. Sometimes, people are unaware of the scope of their disordered eating, and a friend or family member's concern can be instrumental in helping them initially seek treatment.
2. Avoiding talking about weight. Talking about the weight of the afflicted individual is obviously harmful, but talking about weight in general is often harmful well. Avoid fixation on physical appearance in any way.
3. Offer to help with meals. People with eating disorders often experience intense shame, frustration, and fear surrounding mealtime. It may be too difficult to start eating meals with other people—especially if this was one of the more significant symptoms of the eating disorder. Having someone help cook or prepare meals can ease some of the pressure of creating meals and provide healthy, whole foods without the added pressure of having to cook them.
4. Offer to help in other ways. People with eating disorders often turn to their disorders in times of significant stress. Helping to negate some life stressors like cleaning, grocery shopping, or caring for animals can help reduce the overall amount of stress an individual experiences.
5. Learn more about eating disorders. Knowing as much as possible about eating disorders is one of the best ways to support someone. This demonstrates a willingness to understand the struggles someone is facing, and relieves them the pressure of having to explain exactly how they are suffering.
Supporting someone with an eating disorder does not need to be a grand production. Support can be leading an intervention, making meals, or simply being an ally of an individual with an eating disorder. More than anything, it is important to offer love, kindness, and patience as they take the first steps in their recovery journey.